Ms Martina Queally:

I thank the Chairperson and members of the committee for the opportunity to attend today’s meeting. I am the chief officer of HSE community health care east which is referenced in your documents as community health care organisation, CHO, 6. Community health care east describes the same geographical area as that covered by CHO 6, incorporating the former local health offices of Dublin south east, Dublin south and Wicklow. I am joined by Ms Antoinette Barry, the head of service for mental health in CHO 6.

I have submitted appendices to accompany this opening statement which provide detailed information in respect of the governance of mental health services, finance, human resource and service delivery.

As chief officer, I have overall responsibility for the management of HSE community services. As well as mental health, this includes primary care, social care and health and well-being. In line with the community health care organisations report 2014, the area is divided into the eight community health networks, CHNs, shown in the appendices. The community mental health services are delivered primarily by 11 community health mental health teams and work is under way to realign these 11 teams to our eight community health care networks. This will include some realignment with our colleagues in CHO 7, who will address the committee in the near future. This is a really important step in fully integrating our services in line with Sláintecare 2017 and as outlined in the community health care organisation report. This is an important step as to what Ms Colley described earlier in terms of stepped care.

The population of community health care east is 383,000. However, the population covered by mental health services is more than 400,000 due to the aforementioned boundary issues. In addition, we work with colleagues in CHO 5 to provide acute adult inpatient mental health beds at Newcastle Hospital to facilitate easier access for patients in the Gorey area.

In community health care east, mental health services are provided by a combination of direct provision by the HSE and under contract through a service arrangement with St. John of God in its clinics at Cluain Mhuire and Lucena. The HSE provides adult mental health services in Dublin south east and Wicklow and St. John of God, Cluain Mhuire provides adult mental health services in the Dublin south area. St. John of God, Lucena provides child and adolescent mental health services, CAMHS across community health care east and to part of CHO 7.

There is a clear governance arrangement for mental health services in the area. Ms Antoinette Barry is head of service for mental health and reports directly to me as chief officer. The executive clinical director and the area director of nursing in turn report to Ms Barry. There is one mental health executive management team for the overall area which includes senior clinicians and administrative managers and also includes senior manager from St. John of God. All governance and management systems are in line with HSE policies, including quality and patient safety and national financial regulations and so on. I have included a map and a detailed organisational structure in the appendices. There are 560 whole-time equivalent staff employed in our mental health services at the end of November 2017.

Under the programme for Government, a total of 50 additional posts have been approved since 2012. Of these 17 are filled and the balance are in the process of recruitment. A further breakdown of the information is provided by discipline and by team in the appendices.

Recruitment and retention of nursing staff has been a significant service challenge for our area. The main reasons cited by staff in exit interviews are accommodation cost and commute times. We have tried to address this challenge in a number of ways. The introduction of the higher diploma in mental health nursing initiated by community health care east with UCD has been very successful with 38 nurses completing the programme in January 2018, 12 of whom are contracted to work in this area. A further 38 nurses will commence in February 2018, 14 of whom will be contracted to this area. We are continuing to work with UCD as our academic partner to increase the pool of candidates available to us through increasing the number undertaking undergraduate and postgraduate training.

There is a detailed finance breakdown in the appendices but the overall budget for 2017 was €56.86 million.As outlined earlier, mental health services are provided through a number of specialist areas by multidisciplinary teams. We have 11 general adult community mental health teams, two old-age psychiatry teams, nine CAMHS teams, one mental health intellectual disability team and one eating disorder team. We also provide liaison psychiatry to St. Vincent’s University Hospital, St. Michael’s Hospital, St. Columcille’s Hospital and the National Maternity Hospital. These are the three main acute hospitals and the maternity hospital in our area.

In 2018 we will extend the current seven out of seven out-of-hours response for general adult community mental health services, which exists in part of our area, and it will cover the Wicklow primary health care area. We have received approval for four additional posts to cover that and it is a significant improvement. We continue to prioritise co-location of our community mental health services with primary care centres. Centres are planned for Dún Laoghaire, Stillorgan, Bray, Greystones and Arklow. Mental health services are already co-located at Wicklow since 2015. In 2018, a Dublin south-east team will co-locate with primary care services at Churchtown.

Community health care east has a total of 89 adult acute care beds, a breakdown of which is provided in the appendices. In line with national policy, we are developing a plan that will address the number and location of acute beds to ensure all our beds are provided at the most appropriate location. The plan will be costed and will require capital investment. Child and adolescent patients access acute inpatient beds in the Linn Dara unit in Cherry Orchard, Ballyfermot, and the St. Joseph's unit in Fairview. In addition to acute care provision, a range of continuing care, rehabilitation, transitional care beds and community residential places are provided across community health care east. A breakdown is given in the appendices.

We have a number of service improvement initiatives. A mental health recovery committee established in 2017 and was awarded €1.3 million by the service reform fund and €30,000 by Advancing Recovery Ireland, based on a successful proposals to re-orientate services towards recovery. In line with the national clinical programmes, we have established a programme at St. Vincent's University Hospital for the assessment and management of people presenting to the accident and emergency department following self-harm. We are also progressing the implementation of the national clinical programmes for the specialist areas of eating disorders and perinatal mental health. Two suicide resource officers have been appointed to support implementation of the local Connecting for Life action plan, launched in March 2017. A local Connecting for Life oversight group has been established. I am glad to say it has good stakeholder engagement at a cross-sectoral level, which is really important for successful implementation.

A mental health engagement lead was also appointed in February 2017 and he established the community health care east area forum for mental health engagement. In line with the Healthy Ireland policy and the evidence of the need to promote general health and well-being of mental health service users, a significant target for us, we have a number of initiatives that support patient recovery. I will not go into the detail of these but they include Woodlands for Health, which promotes physical activity in outdoor spaces; Kickstart to Recovery, which is a group engagement involving physical activity through football; The Mindful Melodics Choir; and Choices for Health, a lifestyle programme. These are important intersectoral initiatives and require a solid partnership working at a cross-sectoral level. They are focused on health and well-being, particularly in a holistic approach to health and mental health recovery of service users. As a leadership team our emphasis is on continuing to place our service users at the centre of the development of our service, with particular emphasis on recovery and reorientation towards community services.